Health Report

This Plan for Health is an unusual undertaking in two respects. It is part of the Go To 2040 regional master plan along with other human services components that have, historically, been outside the purview of planners, who are usually more concerned with issues such as land use, transportation, and solid waste disposal. And the planning horizon covers three decades, providing a rare opportunity for health planners to engage in truly long range planning. Health is more than medical care: a variety of factors determine the health of individuals and a community. These "underlying determinants" include demographic composition, income and poverty, employment, social status, cultural beliefs and practices, level of educational attainment, environmental conditions, genetics, individual behaviors, and public health measures, in addition to the quality and utilization of health care services.Most planning efforts, which attempt to affect community health, deal only with public health and medical services delivery, even though the other factors are known to have a greater influence on community and individual health. This plan approaches the challenge differently; it focuses on the underlying determinants of health and moves beyond the narrower focus that health planners and public health officials traditionally take. This report identifies the connections that education, land use, transportation, food and hunger, civic engagement, workforce, and the economy have with health, and it focuses on strategies and interventions that can be pursued in these sectors to improve health throughout this region

A PCNN Framework for Blood Cell Image Segmentation

This research presents novel methods for segmenting digital blood cell images under a Pulse Coupled Neural Network (PCNN) framework. A blood cell image contains different types of blood cells found in the peripheral blood stream such as red blood cells (RBCs), white blood cells (WBCs), and platelets. WBCs can be classified into five normal types – neutrophil, monocyte, lymphocyte, eosinophil, and basophil – as well as abnormal types such as lymphoblasts and others. The focus of this research is on identifying and counting RBCs, normal types of WBCs, and lymphoblasts. The total number of RBCs and WBCs, along with classification of WBCs, has important medical significance which includes providing a physician with valuable information for diagnosis of diseases such as leukemia. The approach comprises two phases – segmentation and cell separation – followed by classification of WBC types including detection of lymphoblasts. The first phase presents two methods based on PCNN and region growing to segment followed by a separate method that combines Circular Hough Transform (CHT) with a separation algorithm to find and separate each RBC and WBC object into separate images. The first method uses a standard PCNN to segment. The second method uses a region growing PCNN with a maximum region size to segment. The second phase presents a WBC classification method based on PCNN. It uses a PCNN to capture the texture features of an image as a sequence of entropy values known as a texture vector. First, the parameters of the texture vector PCNN are defined. This is then used to produce texture vectors for the training images. Each cell type is represented by several texture vectors across its instances. Then, given a test image to be classified, the texture vector PCNN is used to capture its texture vector, which is compared to the texture vectors for classification. This two-phase approach yields metrics based on the RBC and WBC counts, WBC classification, and identification of lymphoblasts. Both the standard and region growing PCNNs were successful in segmenting RBC and WBC objects, with better accuracy when using the standard PCNN. The separate method introduced with this research provided accurate WBC counts but less accurate RBC counts. The WBC subimages created with the separate method facilitated cell counting and WBC classification. Using a standard PCNN as a WBC classifier, introduced with this research, proved to be a successful classifier and lymphoblast detector. While RBC accuracy was low, WBC accuracy for total counts, WBC classification, and lymphoblast detection were overall above 96%

On the Uneasy Relationship Between Medicaid and Charity Care

Medicaid and charity care have a lengthy relationship fraught with complications. These complications will remain and in some respects become even more acute following the implementation of the Patient Protection and Affordable Care Act. This article focuses on the uneasy relationship between Medicaid and charity care, one that becomes particularly acute in the context of Medicaid reimbursement. It traces the lineage of Medicaid in charity, and uses Medicaid reimbursement and supplemental payments as lenses through which to examine the relationship between Medicaid and charity care. The tension that we uncover will need to be resolved if Medicaid is to come closer to achieving its arguable aim of placing the poor on the same footing in our health care system as enjoyed by wealthier, privately-insured Americans

On the Uneasy Relationship between Medicaid and Charity Care

Medicaid and charity care have a lengthy relationship fraught with complications. These complications will remain and in some respects become even more acute following the implementation of the Patient Protection and Affordable Care Act. This article focuses on the uneasy relationship between Medicaid and charity care, one that becomes particularly acute in the context of Medicaid reimbursement. It traces the lineage of Medicaid in charity, and uses Medicaid reimbursement and supplemental payments as lenses through which to examine the relationship between Medicaid and charity care. The tension that we uncover will need to be resolved if Medicaid is to come closer to achieving its arguable aim of placing the poor on the same footing in our health care system as enjoyed by wealthier, privately-insured Americans

Tax

Covers cases on the retail sales tax—construciton of home by speculative builder not a retail sale; on retail sales tax as tax on gross sales of vendor; on use tax—consumer and exceptions thereto defined—taxation of property consumed during manufacturing process (Lenihan); and on state taxation of exports (Green)

Pooled analysis of cardiac safety in patients with cancer treated with pertuzumab

Background: Pertuzumab, a human epidermal growth factor receptor (HER) 2 dimerization inhibitor, has demonstrated promising efficacy in combination with trastuzumab in patients with metastatic breast cancer. As HER signaling pathways are not only involved in oncogenesis, but also in myocardial homeostasis, an analysis of cardiac safety data was undertaken in a large group of patients treated with pertuzumab. Patients and methods: A complete database of patients treated with full-dose pertuzumab was used to describe the incidence of asymptomatic left ventricular systolic dysfunction (LVSD) and symptomatic heart failure (HF). Results: Information for 598 unique patients was available for the current analysis. Of the patients treated with pertuzumab alone (n = 331) or pertuzumab in combination with a non-anthracycline-containing cytotoxic (n = 175) or trastuzumab (n = 93), 23 (6.9%), 6 (3.4%), and 6 (6.5%), respectively, developed asymptomatic LVSD and 1 (0.3%), 2 (1.1%), and 1 (1.1%), respectively, displayed symptomatic HF. None of the 15 patients receiving both pertuzumab and erlotinib demonstrated LVSD. Conclusions: Patients treated with pertuzumab experienced relatively low levels of asymptomatic LVSD or symptomatic HF. There was no notable increase in cardiac side-effects when pertuzumab was given in combination with other anticancer agent

Single quantum dot states measured by optical modulation spectroscopy

Using optical modulation spectroscopy, we report the direct observation of absorption lines from excitons localized in GaAs single quantum dot potentials. The data provide a measurement of the linewidth, resonance energy, and oscillator strength of the transitions, and show that states which decay primarily by nonradiative processes can be directly probed using this technique. The experiments establish this technique for the characterization of single quantum dot transitions, thereby complementing luminescence studies. © 1999 American Institute of Physics.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/70527/2/APPLAB-75-19-2933-1.pd